What are genital warts?

A

Genital warts are growths that appear on the genital area – either externally on the vulva, the anus or (for men) the penis, or internally in the vagina or on the cervix. The growths, which typically are soft, moist and flesh-colored, can appear alone or in clusters (often resembling cauliflower) and may be raised or flat, small or large. Less commonly, HPV-related growths may appear red or brown. Note that some warts are so small they are difficult to see, even if they are on the outside of the body.

Q

What causes genital warts?

A

Low-risk types of HPV are spread in the same way as high-risk kinds – through genital skin-to-skin contact, usually during sexual intercourse (vaginal or anal). "Low-risk" means that while the infection can sometimes cause genital warts, there is no danger of it causing cervical cancer. That's why it's possible for a woman to have genital warts, but also to have a normal Pap smear and HPV test. The Pap looks for abnormal cells caused by "high-risk" – or potentially cancer-causing – types of HPV, and the HPV test given along with the Pap is specifically for high-risk types of the virus. (There is a separate test for low-risk HPV that also can be done along with a Pap. However, it is not recommended for routine use, and most insurance companies do not pay for it.)

Low-risk types of HPV are spread in the same way as high-risk kinds – through skin-to-skin contact, usually during sexual intercourse (vaginal or anal).

Note that warts are "site specific." This means genital warts will not spread to other parts of the body, such as the hands (just as warts from the hands will not spread to the genital area). However, the hands can be the vehicle that transfers HPV from one person's genitals to his or her partner's.

Q

Are genital warts common?

A

Although most HPV infections are suppressed by the body before they cause any problems, genital warts are the most common, visible HPV-related complication. Rates vary depending on age and population, but the National Institute for Allergies and Infectious Disease estimates that about 1 out of 272 American adults get genital warts each year, or about 1 million people. Another estimate puts the lifetime risk of getting genital warts at an average of 10%. However, many go away on their own and most others go away with treatment.

Q

How serious are genital warts?

A

People with genital warts often feel uncomfortable and embarrassed, sometimes leading to depression and breaks in relationships. However, warts do not have any broader, or more serious, health effects. The good news is that effective treatments are available.

Q

Can genital warts be prevented?

A

The HPV vaccine developed by Merck (Gardasil®) is designed to protect against the two most common types of low-risk HPV that cause genital warts (as well as against two types of high-risk HPV). However, current data indicate that the vaccine is most effective when given before a person is exposed to these types of HPV through sexual contact. In addition, there are 10 other types of low-risk HPV that the vaccine will not protect against.

Q

Do genital warts go away?

A

The American College of Obstetricians and Gynecologists (ACOG) says studies show that 20-30 percent of genital warts go away on their own, without treatment, within three months. This is most likely to occur if the warts are small in size and number. Warts that do not go away on their own can be eliminated with treatment, although they may come back and require repeat care. Rates of recurrence vary depending on the treatment used and individual circumstances. On average, however, it's estimated that 30 percent of genital warts will come back, requiring about three rounds of treatment.

Q

How are genital warts treated?

A

According to the American College of Obstetricians and Gynecologists (ACOG):

There are two broad types of treatments: self-applied gels and creams and physician-performed therapies. There are no data clearly showing that one treatment is better than another.

Self-applied gels and creams are usually best suited for warts that grow on moist surfaces, such as the "lips" just outside the vagina. However, they may also successfully treat the drier skin on the vulva or penis.

The most frequently used of these gels and creams are:

Condylox® (podofilox) gel: This gel is applied directly to the warts, and works by destroying the warts' cells as well as their ability to reproduce.

Aldara™ (imiquimod) cream: It works by stimulating your immune system to destroy the HPV-infected cells.

Both products must be prescribed by a physician.

Physician-performed treatments include:

Cryotherapy, in which the wart is "frozen" off.

Trichloroacetic acid, which works best for small warts on moist skin.

Electrocautery, in which the wart is destroyed using an electric current.

Laser therapy, which is used to vaporize the wart and is typically used only when warts are extensive or resistant to other treatments.

Surgical removal, which is most appropriate when there are only a few, small warts, or when it is not certain whether the growths are actually HPV-related.

All treatments may cause irritation and discomfort in the area treated, as well as changes in the color of the affected skin. There also is a risk of chronic pain, but that is extremely rare.

Warts that do not go away after six self-applied treatments or three physician-performed therapies should be re-evaluated. A switch in technique may be needed.

Q

Should you avoid sex when genital warts are present?

A

There is a risk of spreading the HPV infection that caused the warts to your partner if you have direct genital contact while the warts are present. Using a condom may reduce that risk.

Most children born to women with a history of genital warts do not experience any HPV-related complications. Only very rarely do warty growths occur in an infant's throat as a result. Cesarean delivery is not usually recommended as a method of preventing this unusual occurrence.